Management of the third stage of labour (for the Optimal Intrapartum Care series edited by Mercedes Bonet, Femi Oladapo and Metin Gulmezoglu)

Weeks, Andrew D ORCID: 0000-0002-1909-337X and Fawcus, Susan (2020) Management of the third stage of labour (for the Optimal Intrapartum Care series edited by Mercedes Bonet, Femi Oladapo and Metin Gulmezoglu). BEST PRACTICE & RESEARCH CLINICAL OBSTETRICS & GYNAECOLOGY, 67. pp. 65-79.

Text
BPRO&G PPH chapter pre-print.pdf - Author Accepted Manuscript
Download (2MB) | Preview

Official URL: http://dx.doi.org/10.1016/j.bpobgyn.2020.03.003

Abstract

The physiology of the third stage of labour is described. Active management reduces the risk of postpartum haemorrhage (PPH), due to the use of a uterotonic agent. Intramuscular Oxytocin 10 IU has the highest efficacy and lowest side effect profile, although ergometrine, carbetocin and misoprostol are also effective. The appropriate uterotonic in different settings such as home birth by unskilled attendants and at caesarean section is discussed. For the latter, there is less consensus on the optimal dose/route of oxytocin, this topic remaining on the research agenda. Delayed cord clamping enables transfusion of blood to the neonate and is recommended rather than early clamping. Controlled cord traction should only be performed by skilled birth attendants and confers minimal advantage in preventing retained placenta. The importance of early recognition of PPH, and preparedness, is emphasised. An approach to medical and surgical management of PPH is presented.

Item Type:	Article
Uncontrolled Keywords:	Postpartum haemorrhage, Birth, Oxytocin, Cord clamping, Placenta
Depositing User:	Symplectic Admin
Date Deposited:	22 Jun 2020 08:19
Last Modified:	18 Jan 2023 23:57
DOI:	10.1016/j.bpobgyn.2020.03.003
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3080625